Breakthrough Bleeding
While regular menstrual cycle control is one of the major benefits of using
oral contraceptives, breakthrough bleeding-spotting between predicted menstrual
periods-is one of the common and annoying side effects of birth control pill
usage. According to a study published in the American Journal of Obstetrics
and Gynecology (1998), breakthrough bleeding is the number one reason
women stop taking the Pill. Women who desire oral contraception should know
that this is not their only alternative if they have experienced breakthrough
bleeding. While we loosely refer to all oral contraceptives as "the Pill",
there are numerous options with different formulations. Women should also know
that according to a study published in the Journal of Reproductive Medicine
in 1995, more than 600,000 unintended pregnancies result per year in the United
States as a result of women who discontinue birth control pill use, yet fail
to use an equally reliable contraceptive method. While that number may be smaller
now as a result of more available contraceptive options (including the contraceptive
patch and emergency contraception), it is still way too high.
Women need to understand that while breakthrough bleeding is not uncommon during
the first three cycles of birth control pill usage, it usually resolves without
intervention. Women who have repeated episodes of breakthrough bleeding should
be comforted to know that the solution is often switching to another birth control
pill with a higher estrogen content. Most women currently taking birth control
pills are on "low-dose" or even "very low-dose" estrogen-containing pills. While
this minimizes many other side effects, women with breakthrough bleeding may
simply require more estrogen. This rarely means that they will be taking a "high
estrogen" pill, but simply a more appropriate dosage for their body's specific
needs. Studies have shown that the lower the estrogen levels a particular pill,
the higher the rates of breakthrough bleeding and spotting. In addition, women
who smoke are more likely to have breakthrough bleeding, as well as to be at
higher risk of serious cardiovascular side effects with higher doses of estrogen
(especially in women over age 35).
Created: 3/17/2004 - Donnica Moore, M.D.
